Starting today, hospitals around the nation will have their 30-day readmission rate count toward penalties from Medicare as laid out in the Affordable Care Act, but New Jersey medical centers are ready, according to one Garden State expert.

Kerry McKean Kelly, vice president of communications for the New Jersey Hospital Association, said today is rather "anticlimactic," as the state's hospitals have been implementing more proactive tools for three years in order to reduce the chance of penalty. However, NJHA does have concerns with the way Medicare calculates readmission rates because it does not distinguish between avoidable and unavoidable readmissions, Kelly said.

Under the new approach, hospitals that have too high a readmission rate for Medicare patients admitted for heart attack, heart failure or pneumonia will pay Medicare back 1 percent of their annual reimbursement.

Kelly said that research produced by a 50-hospital collaborative identified readmission rates were driven largely by community factors, access to timely follow-up appointments with primary care physicians, access to healthy foods, and medication affordability and adherence.

"Some of the actual and practical strategies hospitals are using now to reduce readmissions are, for example, telephonic follow up with patients," Kelly said. "Some hospitals have hired advanced practice nurses to follow up specifically on patients. Some have begun to use more telemedicine equipment so they can remotely monitor vital statistics of the discharged patients."

Those strategies have been working in New Jersey although the decline has been slow here, said Dr. Andrew Miller, medical director for Healthcare Quality Strategies Inc., the firm contracted by Medicare to measure readmissions in New Jersey. According to HQSI, the state has reduced its average Medicare patient readmission rate from 21.8 percent in the second quarter of 2008 to 20.5 percent in the first quarter of 2012.

New Jersey continues to rank among the bottom of states for controlling hospital readmissions; Miller said anywhere from the low 40s to 50th in a study that ranked 53 entities—the states, plus Puerto Rico, Washington, D.C. and the Virgin Islands.

Miller said increased awareness and education in palliative care, hospice and other support services have helped hospitals work collaboratively with other providers to reduce hospital readmissions. Miller said hospitals have traditionally seen their job as what happens inside the facility walls, and the attitude was "it's not the hospital's problem if the patient can't get to their drug store to pick up the medications they need, or can't afford to pay for those medicines, or can't remember how to take them."

A collaboration that has reduced readmissions is the Trenton Health Team – an accountable care organization made up of providers in the six Trenton zip codes. Between July 2010 and June 2012, Trenton Health Team member St. Francis Medical Center reduced readmissions to its own facility more than 27 percent, from 177 to 129, according to Christy Stephenson, executive vice president of strategic and clinical transformation for St. Francis. But, when looking at readmissions of St. Francis patients to other facilities, only an 18.6 percent reduction was seen over the two-year period, she said.